Dayama Anand, Olorunfemi Odunayo, Greenbaum Simon, Stone Melvin E, McNelis John
Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; San Joaquin General Hospital, UC Davis, 500 W Hospital Rd, French Camp, CA 95231, USA.
Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Int J Surg. 2016 Apr;28:185-90. doi: 10.1016/j.ijsu.2016.02.087. Epub 2016 Feb 27.
Frailty is a clinical state of increased vulnerability resulting from aging-associated decline in physiologic reserve. Hip fractures are serious fall injuries that affect our aging population. We retrospectively sought to study the effect of frailty on postoperative outcomes after Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA) for femoral neck fracture in a national data set.
National Surgical Quality Improvement Project dataset (NSQIP) was queried to identify THA and HA for a primary diagnosis femoral neck fracture using ICD-9 codes. Frailty was assessed using the modified frailty index (mFI) derived from the Canadian Study of Health and Aging. The primary outcome was 30-day mortality and secondary outcomes were 30-day morbidity and failure to rescue (FTR). We used multivariate logistic regression to estimate odds ratio for outcomes while controlling for confounders.
Of 3121 patients, mean age of patients was 77.34 ± 9.8 years. The overall 30-day mortality was 6.4% (3.2%-THA and 7.2%-HA). One or more severe complications (Clavien-Dindo class-IV) occurred in 7.1% patients (6.7%-THA vs.7.2%-HA). Adjusted odds ratios (ORs) for mortality in the group with the higher than median frailty score were 2 (95%CI, 1.4-3.7) after HA and 3.9 (95%CI, 1.3-11.1) after THA. Similarly, in separate multivariate analysis for Clavien-Dindo Class-IV complications and failure to rescue 1.6 times (CI95% 1.15-2.25) and 2.1 times (CI95% 1.12-3.93) higher odds were noted in above median frailty group.
mFI is an independent predictor of mortality among patients undergoing HA and THA for femoral neck fracture beyond traditional risk factors such as age, ASA class, and other comorbidities.
Level II.
衰弱是一种因生理储备随年龄增长而下降导致脆弱性增加的临床状态。髋部骨折是影响老年人群的严重跌倒损伤。我们通过回顾性研究，在一个全国性数据集中探讨衰弱对股骨颈骨折全髋关节置换术（THA）和半髋关节置换术（HA）术后结局的影响。
查询国家外科质量改进项目数据集（NSQIP），使用ICD - 9编码确定以股骨颈骨折为主要诊断的THA和HA病例。采用源自加拿大健康与老龄化研究的改良衰弱指数（mFI）评估衰弱情况。主要结局为30天死亡率，次要结局为30天发病率和未能挽救（FTR）。我们使用多因素逻辑回归在控制混杂因素的同时估计结局的比值比。
在3121例患者中，患者平均年龄为77.34 ± 9.8岁。总体30天死亡率为6.4%（THA为3.2%，HA为7.2%）。7.1%的患者发生一种或多种严重并发症（Clavien - Dindo分级IV级）（THA为6.7%，HA为7.2%）。在HA后，衰弱评分高于中位数组的死亡率调整后比值比（OR）为2（95%CI，1.4 - 3.7），在THA后为3.9（95%CI，1.3 - 11.1）。同样，在针对Clavien - Dindo分级IV级并发症和未能挽救的单独多因素分析中，衰弱评分高于中位数组的比值分别高出1.6倍（CI95% 1.15 - 2.25）和2.1倍（CI95% 1.12 - 3.93）。
除年龄、美国麻醉医师协会（ASA）分级和其他合并症等传统危险因素外，mFI是接受HA和THA治疗股骨颈骨折患者死亡率的独立预测因素。
二级。
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